Contraception controversy

February 8, 2012 - Jim Anderson

With the controversy in recent days over the Obama administration’s contraception rule, I’ve had to go back to school, so to speak.

What’s the difference between the morning-after pill and the abortion pill? What’s the difference between over-the-counter emergency contraceptives and prescription-only emergency contraceptives?

A fews day ago, I could have only guessed.

The Obama administration, as you may know, wants nearly all health plans to include birth control and other preventative health services for women. The rule would apply to Catholic universities and hospitals, even though the Catholic church does not condone birth control of any kind.

Heightening the rift is the claim by some church leaders (and conservative politicians and publications) that the Obama administration is mandating coverage for abortion pills.

Drugs that cause abortion, the White House says, are not covered by its rule.

Critics, nonetheless, say the White House is mandating coverage for abortion pills.

The pill that is known as the abortion pill, I’ve learned, is, in fact, an abortion pill. It can be used up to nine weeks after a woman’s last period. It is administered only under the supervision of a health care provider. The abortion pill (mifepristone) is not part of the administration’s contraception policy.

The morning-after pill (actually effective up to 72 hours) is included in the contraception mandate. It works primarily by inhibiting the ovaries from producing eggs. In that sense, it’s not an abortion pill.

But there’s a point of departure.

The morning-after pill (sold as Plan B) might prevent a fertilized egg from implanting in the womb, which some consider equivalent to abortion. Many fertilized eggs never implant in the womb — even without Plan B — but critics insist that making the womb less receptive is equivalent to abortion.

Unlike the abortion pill, Plan B is not effective once implantation has begun. For the most part, medical experts equate pregnancy with implantation, and reject the notion that Plan B is an abortion pill.

A new form of emergency contraception sold as ella (ulipristal) is also part of the birth control order. Ella delays ovulation and blocks sperm from fertilizing an egg up to five days after unprotected sex. In that sense, it would be considered contraception — and not an abortion pill.

But, again, a point of departure.

Ella, just like Plan B, may prevent attachment of a fertilized egg to the womb. Also, it is a chemical cousin to the abortion pill. The prescription-only ella comes in much smaller doses than the abortion pill, but critics claim it has the potential to dislodge a growing embryo from the womb. That, they say, makes it an abortion pill.

Defenders claim that dislodging an embryo would require highly-elevated and ill-advised doses, which, of course, is not part of the Obama order. Emergency contraception, including ella, does not work if a woman is already pregnant, defenders say, and will not cause an abortion.

Ella, the critics repeat, can cause the demise of an embryo already implanted the womb and that makes it an abortion pill. Some stories critical of Obama simply refer to ella as an abortion pill — without further context.

The line between contraception and abortion can, indeed, be a blurry one. (Emergency contraceptives are not always effective, a fact that might get lost in a debate in which they are classified by some critics as abortifacients.)

I’ve heard bishops say that Obama is ordering them to cover abortion-inducing drugs. I’ve heard defenders of Obama trying to refute that claim by addressing only Plan B and not ella. I’ve heard critics of ella ignoring the dosing issue. I’ve heard defenders of ella ignoring its chemical similarities to the abortion pill.